School of Health Economic and Management, Nanjing University of Chinese Medicine, Nanjing, China.
Center for Global Public Health, Chinese Center for Disease Control and Prevention , Beijing, China.
BMC Complement Med Ther. 2024 Oct 14;24(1):369. doi: 10.1186/s12906-024-04659-z.
With the increasing prevalence of chronic diseases, the demand for medical services from chronic disease patients has become diversified and personalized. The advantages and role of traditional Chinese medicine in the prevention and treatment of chronic diseases gradually emerging. The preferences and willingness to pay for traditional Chinese medicine services (TCMS) among patients with chronic diseases, as well as any disparities between urban and rural patients, have not been examined in past studies.
This study aimed to investigate the preferences of chronic disease patients for TCMS, explore the value/importance that patients place on different treatment attributes, and evaluate whether there are urban-rural differences in their preferences and willingness to pay for TCMS.
A total of 317 patients from Jiangsu Province, China participated in a discrete choice experiment that elicited the preferences for TCMS. The choice questions were constructed by six attributes: out-of-pocket (OOP) cost, institution, medical provider, treatment method, treatment duration, treatment efficacy. Mixed logit models were used to estimate the stated preference and marginal willingness to pay for each attribute.
The choice preferences of chronic disease patients for TCMS in this study were influenced by the four attributes: institution, treatment method, and treatment efficacy, and OOP cost. Improvements in treatment efficacy were the most concerning, followed by being treated in traditional Chinese medicine (TCM) hospital. Patients were willing to pay more to get better treatment outcomes. Compared with primary care institutions, patients were willing to pay more for treatment in TCM hospitals. The preferences for economic attribute (OOP cost) varied between urban and rural areas, and rural patients tended to favor scenarios that imposed a lower economic burden on them.
The chronic disease patients' preferences for TCMS were determined mainly by treatment efficacy but also by institution, treatment method and OOP cost. The urban-rural difference in preference identified in this study highlights that effective policy interventions should consider the characteristics of patients' demand in different regions.
随着慢性病患病率的增加，慢性病患者对医疗服务的需求变得多样化和个性化。中医药在慢性病防治中的优势和作用逐渐显现。然而，既往研究并未考察慢性病患者对中医药服务（TCMS）的偏好和支付意愿，以及城乡患者之间是否存在差异。
本研究旨在调查慢性病患者对 TCMS 的偏好，探讨患者对不同治疗属性的重视程度，并评估其对 TCMS 的偏好和支付意愿是否存在城乡差异。
本研究采用离散选择实验（DCE）方法，共纳入江苏省 317 名慢性病患者。通过构建包含自付费用（OOP）、机构、医疗提供者、治疗方法、治疗持续时间和治疗效果六个属性的选择问题，利用混合 logit 模型估计患者对 TCMS 的偏好和边际支付意愿。
慢性病患者对 TCMS 的选择偏好受到机构、治疗方法和治疗效果以及 OOP 成本四个属性的影响。治疗效果的改善是最受关注的，其次是在中医医院接受治疗。患者愿意支付更多的费用来获得更好的治疗效果。与基层医疗机构相比，患者更愿意为在中医医院接受治疗支付更多费用。城乡患者对经济属性（OOP 成本）的偏好存在差异，农村患者更倾向于选择经济负担较低的方案。
慢性病患者对 TCMS 的偏好主要由治疗效果决定，但也受到机构、治疗方法和 OOP 成本的影响。本研究中发现的城乡偏好差异表明，有效的政策干预应考虑不同地区患者需求的特点。
